Florida SB 1640: Payments for Health Care Services

Bill Text

1640 
Medicaid Dental Pilot Program for Persons with Disabilities 
2026-01-09T08:42:01Z 
Defining the term “persons with disabilities”; requiring the Agency for Health Care Administration to establish and operate a Medicaid dental pilot program in a specified region to provide enhanced dental services to persons with disabilities; specifying dental services covered by the pilot program; requiring the agency to reimburse dental providers under the pilot program at a specified rate; requiring the agency to collect certain data on the pilot program, etc. 
Original Filed Version 
2026 
S 
2026-07-01T00:00:00Z 
GB 
General Bill 
__ 

 Florida Senate - 2026 SB 1640 

 By Senator Smith 

 17-01369A-26 20261640__ 
 1 A bill to be entitled 
 2 An act relating to the Medicaid dental pilot program 
 3 for persons with disabilities; creating s. 409.9079, 
 4 F.S.; defining the term “persons with disabilities”; 
 5 requiring the Agency for Health Care Administration to 
 6 establish and operate a Medicaid dental pilot program 
 7 in a specified region to provide enhanced dental 
 8 services to persons with disabilities; specifying 
 9 eligibility for participation in the pilot program; 
 10 specifying dental services covered by the pilot 
 11 program; providing construction; requiring the agency 
 12 to reimburse dental providers under the pilot program 
 13 at a specified rate; providing for the delivery of 
 14 services under the pilot program through at least two 
 15 licensed dental managed care organizations meeting 
 16 certain criteria; requiring the agency to submit any 
 17 necessary state plan amendments or federal waiver 
 18 applications for federal approval; requiring the 
 19 agency to collect certain data on the pilot program; 
 20 requiring the agency to submit a report on the pilot 
 21 program to the Governor and the Legislature by a 
 22 specified date; providing for expiration of the pilot 
 23 program; providing an effective date. 
 24 
 25 Be It Enacted by the Legislature of the State of Florida: 
 26 
 27 Section 1. Section 409.9079, Florida Statutes, is created 
 28 to read: 
 29 409.9079 Medicaid dental pilot program for persons with 
 30 disabilities in Region E.— 
 31 (1) DEFINITION.—As used in this section, the term “persons 
 32 with disabilities” means Medicaid-eligible individuals who: 
 33 (a) Receive Supplemental Security Income (SSI) on the basis 
 34 of disability; 
 35 (b) Are enrolled in a home and community-based services 
 36 (HCBS) waiver program under s. 1915(c) of the Social Security 
 37 Act; or 
 38 (c) Meet federal disability criteria under 42 U.S.C. s. 
 39 1382c(a)(3), as determined by the Social Security Administration 
 40 or the state Medicaid program. 
 41 (2) PILOT PROGRAM ESTABLISHED.—The agency shall establish 
 42 and operate a 3-year Medicaid dental pilot program in Region E 
 43 of the Statewide Medicaid Managed Care program to provide 
 44 enhanced dental services to persons with disabilities. 
 45 (3) ELIGIBILITY.—Participation in the pilot program is 
 46 limited to persons with disabilities who reside in Region E and 
 47 are enrolled in the Medicaid program. 
 48 (4) COVERED SERVICES.— 
 49 (a) Dental services provided under the pilot program must 
 50 include all of the following: 
 51 1. Routine diagnostic and preventive care, including 
 52 examinations, cleanings, and radiographs. 
 53 2. Basic dental services, including fillings and 
 54 extractions. 
 55 3. Major dental services, including root canals, crowns, 
 56 dentures, and other dental prostheses. 
 57 4. Emergency dental services. 
 58 5. Any additional dental services the agency determines are 
 59 necessary to promote oral health and prevent disease. 
 60 (b) Services provided under this subsection supplement, and 
 61 do not replace, dental benefits available under ss. 409.906 and 
 62 409.973. 
 63 (5) REIMBURSEMENT.—The agency shall reimburse providers of 
 64 dental services under the pilot program at a rate equivalent to 
 65 80 percent of the 50th percentile of the 2024 Usual, Customary, 
 66 and Reasonable fees, as determined by the American Dental 
 67 Association or a comparable benchmark approved by the agency. 
 68 (6) MANAGED CARE PARTICIPATION.—The pilot program must be 
 69 delivered through at least two licensed dental managed care 
 70 organizations that meet agency standards and have demonstrated 
 71 experience in providing dental services to persons with 
 72 disabilities. 
 73 (7) FEDERAL APPROVAL.—The agency shall submit for federal 
 74 approval any Medicaid state plan amendments or federal waiver 
 75 applications necessary to implement the pilot program. 
 76 (8) EVALUATION; REPORT.— 
 77 (a) The agency shall collect pilot program data on all of 
 78 the following: 
 79 1. Access to dental care. 
 80 2. Utilization of services. 
 81 3. Reimbursement expenditures. 
 82 4. Oral health outcomes for participants. 
 83 (b) By January 1, 2029, the agency shall submit a report